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Limaye RJ, Singh P, Fesshaye B, Lee C, Schue J, Karron RA. "Why has this new vaccine come and for what reasons?" key antecedents and questions for acceptance of a future maternal GBS vaccine: Perspectives of pregnant women, lactating women, and community members in Kenya. Hum Vaccin Immunother 2024; 20:2314826. [PMID: 38345050 PMCID: PMC10863339 DOI: 10.1080/21645515.2024.2314826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
Group B streptococcus (GBS) is a leading global cause of neonatal sepsis and meningitis, stillbirth, and puerperal sepsis. While intrapartum antibiotic prophylaxis (IAP) is a currently available GBS disease prevention strategy, IAP is programmatically complex to implement, precluding use in low- and middle-income countries. In Kenya, 2% of stillbirths are attributable to GBS infection. Two maternal GBS vaccines are in late-stage clinical development. However, licensure of a maternal GBS vaccine does not translate into reduction of disease. We conducted 28 in-depth interviews with pregnant people, lactating people, and community members across two counties in Kenya to better understand the attitudes and informational needs of primary vaccine beneficiaries. We identified two emerging themes from the data. The first focused on antecedents to maternal GBS vaccine acceptability. The most common antecedents focused on the vaccine's ability to protect the baby and/or the mother, followed by community sensitization before the vaccine was available. The second key theme focused on questions that would need to be addressed before someone could accept a maternal GBS vaccine. Three key categories of questions were identified, including vaccine safety compared to vaccine benefits, who gets the vaccine, and how the vaccine works. Realizing the potential benefits of a future GBS maternal vaccine will require a multifactorial approach, including ensuring that communities are aware of GBS-related harms as well as the safety and effectiveness of a maternal GBS vaccine. Our study contributes to informing this multifactorial approach by elucidating the attitudes and concerns of key populations.
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Affiliation(s)
- Rupali J. Limaye
- Department of International Health, Department of Epidemiology, Department of Health, Behavior & Society, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prachi Singh
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Berhaun Fesshaye
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clarice Lee
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Schue
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth A. Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Oscorbin IP, Gordukova MA, Davydova NV, Zinovieva NV, Kovzel EF, Andries L, Kudlay DA, Filipenko ML. Multiplex droplet digital PCR for 22q11.2 microdeletions screening and DiGeorge syndrome diagnostics. Clin Chim Acta 2024; 563:119903. [PMID: 39127298 DOI: 10.1016/j.cca.2024.119903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND AIMS DiGeorge syndrome (DGS) is a genetic disorder manifesting in polymorphic symptoms related to developmental abnormalities of various organs including thymus. DGS is caused by microdeletions in the 22q11.2 region between several low copy repeats (LCR) occurring in approximately 1 in 4000 live births. Diagnosis of DGS relies on phenotypic examination, qPCR, ultrasound, FISH, MLPA and NGS which can be relatively inaccurate, time-consuming, and costly. MATERIALS AND METHODS A novel multiplex droplet digital PCR (ddPCR) assay was designed, optimized and validated for detection and mapping 22q11.2 microdeletions by simultaneous amplification of three targets - TUPLE1, ZNF74, D22S936 - within the deletion areas and one reference target - RPP30 - as an internal control. RESULTS The assay reliable identified microdeletions when the template concentration was >32 copies per reaction and successfully detected LCR22A-B, LCR22A-C, LCR22A-D, and LCR22B-C deletions in clinical samples from 153 patients with signs of immunodeficiency. In patients with the microdeletions, flow cytometry detected a significant increase in B-cell and natural killer cell counts and percentages, while T-cell percentages and T-cell receptor excision circle (TREC) numbers decreased. CONCLUSION The designed ddPCR assay is suitable for diagnosing DGS using whole blood and blood spots.
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Affiliation(s)
- Igor Petrovich Oscorbin
- Laboratory of Pharmacogenomics, The Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences (ICBFM SB RAS), Novosibirsk 630090, Russia.
| | | | | | | | - Elena Fedorovna Kovzel
- Clinical Immunology, Allergology, Pulmonology Program, Corporate Fund "University Medical Center" of Nazarbayev University, Astana, Kazakhstan
| | - Lucia Andries
- Laboratory of Clinical Immunology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chișinău, Moldova
| | - Dmitry Anatolyevich Kudlay
- The Department of Pharmacology, Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Pogodinskaya St. 1, Moscow 119991, Russia
| | - Maxim Leonidovich Filipenko
- Laboratory of Pharmacogenomics, The Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences (ICBFM SB RAS), Novosibirsk 630090, Russia
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Babar ZUD. A conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs). Res Social Adm Pharm 2024; 20:934-939. [PMID: 38908991 DOI: 10.1016/j.sapharm.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Building effective medicine pricing policies is a challenging task in all high-, middle- and low-income countries. In high-income countries have stable health systems in place, trained workforce, as well as specialised agencies to evaluate innovative drugs for reimbursement. However, in low- and middle-income countries (LMICs) the challenges are manifold. A large majority of low- and middle-income countries lack technical expertise either to evaluate new medicines or to set efficient medicine prices. The countries also lack comparator reference pricing data to set prices. Also, there are significant out-of-pocket expenditures as people pay for medicines by themselves. An effective medicine pricing policy is vital in the context that it can be used as a tool to improve access and affordability among the masses. This discussion paper presents a conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs). The enablers to build effective medicine pricing policies are also discussed. This includes (a) data and statistics on the pharmaceutical situation of the country (b) Having a national medicine policy in the country (c) The availability of the medicine pricing data and (d) Human resources and technical capacity. WHO has recommended several strategies including External Price Referencing (EPR), Internal Reference pricing, Value-based pricing, Cost-plus pricing, and Generic medicine policies to build a pricing policy. However, this information is generic and it's a complex task for countries to tailor to their needs, hence a critical analysis is provided on these policies. The concepts related to fair medicine pricing, providing information to consumers and price transparency are also discussed.
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Kwong A, Leung R, Chan TC, Khandelwal A, Mishra K, Huang M. Cost-effectiveness of Pembrolizumab in Combination with Chemotherapy as Neoadjuvant Treatment and Continued as a Single Agent Adjuvant Treatment for High-Risk Early-Stage Triple-Negative Breast Cancer in Hong Kong. Oncol Ther 2024; 12:525-547. [PMID: 39037537 PMCID: PMC11333381 DOI: 10.1007/s40487-024-00285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/23/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION The phase III randomized KEYNOTE-522 trial demonstrated that pembrolizumab in combination with chemotherapy as neoadjuvant treatment followed by adjuvant pembrolizumab (pembrolizumab + chemotherapy) provided significant improvements in event-free survival (EFS) and overall survival (OS) for patients with high-risk early-stage triple-negative breast cancer (eTNBC). The objective was to assess the cost-effectiveness of pembrolizumab + chemotherapy compared to neoadjuvant chemotherapy alone (chemotherapy) in patients with high-risk eTNBC from a Hong Kong third-party payer perspective. METHODS A multistate transition model with four health states (event-free), locoregional recurrence, distant metastases, and death) was developed to assess the lifetime medical costs and health outcomes (3% annual discount), along with incremental cost-effectiveness ratios (ICERs) using efficacy and safety data from the KEYNOTE-522 trial. The health state utilities were derived from KEYNOTE-522 Euro-QoL-five-dimension five-level questionnaire (EQ-5D-5L) data. Costs were expressed in 2022 Hong Kong dollars (HKD). Scenario and sensitivity analyses were performed to assess the robustness of results. RESULTS Over a 32-year time horizon, base case results showed that pembrolizumab + chemotherapy was associated with a 3.42 year longer EFS and expected gains of 3.05 life years (LYs) and 2.45 quality-adjusted life years (QALYs) compared to chemotherapy. The resultant ICERs were HKD 135,200 per QALY gained and HKD 108,463 per LY gained, which were lower than the World Health Organization (WHO) cost-effectiveness threshold of three times gross domestic product (GDP) per capita for Hong Kong of HKD 1,171,308 per QALY. The one-way sensitivity analyses (OWSA) and probabilistic sensitivity analysis (PSA) showed the results were robust across various inputs and alternative scenarios. CONCLUSION On the basis of the analysis conducted for a 56-year-old cohort with high-risk eTNBC and assumptions in the model, pembrolizumab + chemotherapy represents a cost-effective proposition (as the ICER is approximately 35% of the GDP per capita in Hong Kong) for patients with high-risk eTNBC in Hong Kong.
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Affiliation(s)
- Ava Kwong
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
| | - Roland Leung
- Division of Hematology and Medical Oncology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Tsz Ching Chan
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Anvi Khandelwal
- Complete Health Economics and Outcomes Research Solutions (CHEORS), North Wales, PA, USA
| | - Kshama Mishra
- Complete Health Economics and Outcomes Research Solutions (CHEORS), North Wales, PA, USA
| | - Min Huang
- Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
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Sudhinaraset M, Gipson JD, Nakphong MK, Soun B, Afulani PA, Upadhyay UD, Patil R. Person-centered abortion care scale: Validation for medication abortion in the United States. Contraception 2024; 137:110485. [PMID: 38754758 DOI: 10.1016/j.contraception.2024.110485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. STUDY DESIGN This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. RESULTS Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. CONCLUSION This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. IMPLICATIONS This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.
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Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States.
| | - Jessica D Gipson
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States
| | - Michelle K Nakphong
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Brenda Soun
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Patience A Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rajita Patil
- UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States
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Houmaid H, Harou K, Fakhir B, Bassir A, Boukhanni L, Aboulfalah A, Asmouki H, Soummani A. Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review. Contracept Reprod Med 2024; 9:42. [PMID: 39192372 DOI: 10.1186/s40834-024-00302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND We report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures. CASE PRESENTATION A 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications. CONCLUSION This case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it's the transuterovesical migration, before concluding wrongly to its expulsion. It's a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.
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Affiliation(s)
- Hanane Houmaid
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco.
| | - Karam Harou
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Bouchra Fakhir
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahlam Bassir
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Lahcen Boukhanni
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Abderrahim Aboulfalah
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Hamid Asmouki
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Abderraouf Soummani
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
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Logan RAE, Mäurer JB, Wapler C, Ingham VA. Uridine diphosphate (UDP)-glycosyltransferases (UGTs) are associated with insecticide resistance in the major malaria vectors Anopheles gambiae s.l. and Anopheles funestus. Sci Rep 2024; 14:19821. [PMID: 39191827 DOI: 10.1038/s41598-024-70713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
Malaria remains one of the highest causes of morbidity and mortality, with 249 million cases and over 608,000 deaths in 2022. Insecticides, which target the Anopheles mosquito vector, are the primary method to control malaria. The widespread nature of resistance to the most important insecticide class, the pyrethroids, threatens the control of this disease. To reverse the stall in malaria control there is urgent need for new vector control tools, which necessitates understanding the molecular basis of pyrethroid resistance. In this study we utilised multi-omics data to identify uridine-diphosphate (UDP)-glycosyltransferases (UGTs) potentially involved in resistance across multiple Anopheles species. Phylogenetic analysis identifies sequence similarities between Anopheline UGTs and those involved in agricultural pesticide resistance to pyrethroids, pyrroles and spinosyns. Expression of five UGTs was characterised in An. gambiae and An. coluzzii to determine constitutive over-expression, induction, and tissue specificity. Furthermore, a UGT inhibitor, sulfinpyrazone, restored susceptibility to pyrethroids and DDT in An. gambiae, An. coluzzii, An. arabiensis and An. funestus, the major African malaria vectors. Taken together, this study provides clear association of UGTs with pyrethroid resistance as well as highlighting the potential use of sulfinpyrazone as a novel synergist for vector control.
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Affiliation(s)
- Rhiannon Agnes Ellis Logan
- Parasitology Department, Medical Faculty, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Julia Bettina Mäurer
- Parasitology Department, Medical Faculty, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Charlotte Wapler
- Parasitology Department, Medical Faculty, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Victoria Anne Ingham
- Parasitology Department, Medical Faculty, Centre for Infectious Diseases, University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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Durska A, Szpecht D, Gotz-Więckowska A, Strauss E. Association of ACE and AGTR1 variants with retinopathy of prematurity: a case-control study and meta-analysis. J Appl Genet 2024:10.1007/s13353-024-00900-0. [PMID: 39186201 DOI: 10.1007/s13353-024-00900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
Retinopathy of prematurity (ROP) is a major cause of childhood blindness worldwide, linked to gene variants in the renin-angiotensin-aldosterone system, including angiotensin-converting enzyme (ACE) and angiotensin II receptor type 1 (AGTR1). This study aims to evaluate the association between ACE insertion/deletion (I/D) and AGTR1 rs5186A > C variants with the occurrence and progression of ROP in a Polish cohort. A total of 377 premature infants were enrolled in the study. The ACE variant was evaluated using PCR, and AGTR1 was assessed using TaqMan probes. Clinical characteristics, including risk factors and comorbidities, were documented. A meta-analysis of the effects of the studied variants on ROP was also conducted. The AGTR1 rs5186C allele was significantly associated with both the progression of ROP and treatment outcomes. Homozygotes exhibited a 2.47-fold increased risk of developing proliferative ROP and a 4.82-fold increased risk of treatment failure. The impact of this allele increased at low birth weight. A meta-analysis, including 191 cases and 1661 controls, indicated an overall risk of 1.7 (95%CI 1.02-2.84) for the recessive effect of the rs5186C allele. The ACE variant did not show a significant association with ROP in our population; however, a meta-analysis of 996 cases and 2787 controls suggested a recessive effect of the insertion allele (an odds ratio of 1.21 (95%CI 1.00-1.60)). These results indicate that gain-of-function AGTR1 variants may play a crucial role in the development of ROP, potentially by promoting angiogenesis and pro-inflammatory effects. Screening for these variants could facilitate the development of personalized risk assessment and treatment strategies for ROP.
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Affiliation(s)
- Anna Durska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Gotz-Więckowska
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Strauss
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznan, Poland.
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Aghazadeh N, Jabbari Farooji S, Haghani S, Amini L. Effectiveness of multimedia education on the childbearing intention in one-child women: a field trial study. BMC MEDICAL EDUCATION 2024; 24:921. [PMID: 39183310 PMCID: PMC11346200 DOI: 10.1186/s12909-024-05784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND childbearing is a key component of population movements and sustainable development in low-fertility nations. This study was conducted with the aim of determining the impact of multimedia education on the childbearing intention in One-child women of Maragheh city. METHOD In this intervention study in Maragheh in 2023, 94 women with one child were randomly selected and placed in two intervention and control groups. Before the intervention, people were examined using demographic information and Miller's questionnaire of desire to have children. Then, For the intervention group, three 60-minute multimedia training videos were shown in person for three weeks, and the control group did not receive any training. The data were collected using the researcher's demographic questionnaire and Miller's childbearing questionnaire in three stages before the intervention, immediately after and six weeks after the intervention. Data analysis was done with SPSS version 16 software. RESULTS There was no significant difference between the two groups in terms of the average score of desire to have children and demographic variables (p > 0.05). Before the intervention, there was no significant difference between the intervention and control groups in terms of the demographic characteristics of the subjects and the average score of women's willingness to have children in the positive and negative dimensions. While after the multimedia educational intervention, the average score of desire to have children in positive and negative dimensions, immediately after the intervention and six weeks after the intervention, had a significant difference compared to before the intervention (p < 0.001). CONCLUSION The findings of the study showed that carrying out multimedia educational interventions to single-child women can have a positive effect on their desire to have children. It seems that the implementation of such programs is effective in the conscious decision of families to have children and ultimately increases the intention of the individual to carry out the behavior. TRIAL REGISTRATION Iranian Registry of Clinical Trials: IRCT20230227057549N1. Date of registration: 16/04/2023. URL: https://irct.behdasht.gov.ir/ .
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Affiliation(s)
- Nasrin Aghazadeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Maragheh University of Medical Sciences, Maragheh, Iran
| | | | - Shima Haghani
- Nursing and Midwifery Care Research Center (NCRC), Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
- Nursing and Midwifery Care Research Center (NCRC), Iran University of Medical Sciences, Tehran, Iran.
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Li GF, Yu G, Li MF. Predicting Plasma Protein Binding of Drugs in Special Populations: Are all models wrong, but can some be recalibrated, refined, and become more useful? J Pharm Sci 2024:S0022-3549(24)00345-9. [PMID: 39181448 DOI: 10.1016/j.xphs.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Guo-Fu Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China; Subei People's Hospital, Yangzhou, China.
| | - Guo Yu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Ming-Feng Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
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Tenza S, Mampuru L, Moji M, Zulu S, Begg L, Bruce IV, Reddy K, Friedland BA, Palanee-Phillips T, Mathur S. "Killing two birds with one stone" - a qualitative study on women's perspectives on the dual prevention pill in Johannesburg, South Africa. BMC Womens Health 2024; 24:462. [PMID: 39174929 PMCID: PMC11342472 DOI: 10.1186/s12905-024-03269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/17/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa. METHODS Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16-40 stratified by ages (16-17, 18-24, 25-40), half of whom were COC users. We explored adolescent girls and women's opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis. RESULTS The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient "two-in-one" solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. CONCLUSIONS/SIGNIFICANCE The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.
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Affiliation(s)
- Siyanda Tenza
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lydia Mampuru
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Mpho Moji
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Sihle Zulu
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Lorna Begg
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Irene V Bruce
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Krishnaveni Reddy
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
- Center for Biomedical Research, Population Council, New York, NY, USA
| | | | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology; School of Public Health, University of Washington, Seattle, USA
| | - Sanyukta Mathur
- Social and Behavioral Research, Population Council, Washington, DC, USA
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12
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Rao KD, Bairwa M, Mehta A, Hyat S, Ahmed R, Rajapaksa L, Adams AM. Improving urban health through primary health care in south Asia. Lancet Glob Health 2024:S2214-109X(24)00121-9. [PMID: 39178875 DOI: 10.1016/s2214-109x(24)00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 08/26/2024]
Abstract
South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.
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Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Mohan Bairwa
- All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Mehta
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Hyat
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rushdia Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lalini Rajapaksa
- Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
| | - Alayne M Adams
- Factor-Inwentash Faculty of Social Work, McGill University, Montreal, QC, Canada
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13
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Lawford H, Tukia ‘O, Takai J, Sheridan S, Lau CL. Operational research to inform post-validation surveillance of lymphatic filariasis in Tonga study protocol: History of lymphatic filariasis elimination, rational, objectives, and design. PLoS One 2024; 19:e0307331. [PMID: 39163407 PMCID: PMC11335152 DOI: 10.1371/journal.pone.0307331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF), a mosquito-borne helminth infection, is an important cause of chronic disability globally. The World Health Organization has validated eight Pacific Island countries as having eliminated lymphatic filariasis (LF) as a public health problem, but there are limited data to support an evidence-based approach to post-validation surveillance (PVS). Tonga was validated as having eliminated LF in 2017 but no surveillance has been conducted since 2015. This paper describes a protocol for an operational research project investigating different PVS methods in Tonga to provide an evidence base for national and regional PVS strategies. METHODS Programmatic baseline surveys and Transmission Assessment Surveys conducted between 2000-2015 were reviewed to identify historically 'high-risk' and 'low-risk' schools and communities. 'High-risk' were those with LF antigen (Ag)-positive individuals recorded in more than one survey, whilst 'low-risk' were those with no recorded Ag-positives. The outcome measure for ongoing LF transmission will be Ag-positivity, diagnosed using Alere™ Filariasis Test Strips. A targeted study will be conducted in May-July 2024 including: (i) high and low-risk schools and communities, (ii) boarding schools, and (iii) patients attending a chronic-disease clinic. We estimate a total sample size of 2,010 participants. CONCLUSIONS Our methodology for targeted surveillance of suspected 'high-risk' populations using historical survey data can be adopted by countries when designing their PVS strategies. The results of this study will allow us to understand the current status of LF in Tonga and will be used to develop the next phase of activities.
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Affiliation(s)
- Harriet Lawford
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - ‘Ofa Tukia
- Public Health Division, Ministry of Health, Nuku’alofa, Tonga
| | - Joseph Takai
- Public Health Division, Ministry of Health, Nuku’alofa, Tonga
| | - Sarah Sheridan
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Colleen L. Lau
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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14
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Kabunga A, Kigongo E, Okalo P, Udho S, Grace AA, Tumwesigye R, Akello AR, Musinguzi M, Acup W, Nabaziwa J, Shikanga EM, Namata H. Burnout and quality of life among healthcare workers in central Uganda. PLoS One 2024; 19:e0305713. [PMID: 39159180 PMCID: PMC11332927 DOI: 10.1371/journal.pone.0305713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/04/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The widespread problem of burnout among healthcare workers is not only common but also a significant concern that impacts the entire healthcare system in Uganda. It is essential to understand the connection between burnout and quality of life among healthcare workers in the specific context of central Uganda, where healthcare professionals face high patient volumes, limited resources, exposure to infectious diseases, and socioeconomic challenges. This study examined the relationship between burnout and quality of life among healthcare workers in central Uganda. METHODS This research utilized a cross-sectional study conducted across various healthcare settings in central Uganda. The data were analyzed at descriptive, bivariate, and multivariate levels. The relationship between dependent and independent variables was evaluated using an independent t-test for binary variables and a one-way analysis of variance (ANOVA) for categorical variables. Significance was determined with a reported p-value, with relationships deemed significant at p < 0.2. For multivariable analysis, multiple linear regression was employed using a forward selection method, with significance set at 5% (p < 0.05). RESULTS Our findings indicate that nearly 40% of healthcare workers reported experiencing high levels of burnout. The average score for overall quality of life was 10.71 (±4.89), with variations observed across different domains. The study reveals a significant connection between socio-demographic factors, burnout, and overall quality of life, emphasizing the impact of job category, supervisory support, sleep quality, and burnout on the well-being of healthcare workers. Predictive analysis illustrates how these factors influence both overall quality of life scores and scores in specific domains. Particularly noteworthy is that nurses and technicians tend to have a lower quality of life compared to physicians. CONCLUSION The results underscore the relationship between socio-demographic factors, burnout, and particular aspects of quality of life. Notably, job category, supervisory support, sleep quality, and burnout stand out as significant factors shaping the well-being of healthcare workers. Nurses and technicians encounter distinct challenges, suggesting the need for interventions tailored to their needs. Addressing issues such as inadequate supervisory support, burnout, and sleep-related problems is recognized as a potential approach to improving the overall quality of life among healthcare workers.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira, Uganda
| | - Eustes Kigongo
- Department of Environmental Health and Disease Control, Lira University, Lira, Uganda
| | | | - Samson Udho
- Department of Midwifery, Lira University, Lira, Uganda
| | | | | | - Anne Ruth Akello
- Department of Environmental Health and Disease Control, Lira University, Lira, Uganda
| | | | - Walter Acup
- Department of Community Health, Lira University, Lira, Uganda
| | - Jannat Nabaziwa
- Department of Community Health, Lira University, Lira, Uganda
| | | | - Haliama Namata
- Department of Mental Health, Makerere University, Kampala, Uganda
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15
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Chavula MP, Matenga TFL, Maritim P, Munakampe MN, Habib B, Liusha N, Banda J, Sinyangwe NN, Halwiindi H, Mweemba C, Mubanga A, Kaonga P, Chewe M, Phiri H, Zulu JM. Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia. Health Res Policy Syst 2024; 22:112. [PMID: 39160603 PMCID: PMC11331766 DOI: 10.1186/s12961-024-01194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia. METHODS A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance. FINDINGS The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation. CONCLUSIONS Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Tulani Francis L Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patricia Maritim
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
| | - Margarate N Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
| | - Batuli Habib
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Namakando Liusha
- Ministry of Health, Kitwe Teaching Hospital, Off Kumboka Drive, P.O. Box 20969, Kitwe, Zambia
| | - Jeremiah Banda
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ntazana N Sinyangwe
- Department of Environmental Health, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Hikabasa Halwiindi
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Chris Mweemba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Angel Mubanga
- Ministry of Health, Ndeke House, Haile Selassie Avenue, P.O. box 30205, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mwimba Chewe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Henry Phiri
- Ministry of Health, Ndeke House, Haile Selassie Avenue, P.O. box 30205, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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16
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Byabagambi JB, Hollingsworth B, Limmer M. Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study. BMC Public Health 2024; 24:2232. [PMID: 39152417 PMCID: PMC11329999 DOI: 10.1186/s12889-024-19796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Despite voluntary medical male circumcision (VMMC) being a cost-effective intervention for preventing HIV transmission, its scale-up has faced challenges. Several interventions to address these challenges in priority countries, including Uganda, have not yielded the desired results. This cross-sectional qualitative study aimed to explore the factors that affect the demand for VMMC and identify possible solutions. Semi-structured phone interviews were conducted with 29 males aged at least 18 and not more than 65 drawn randomly from a database representative of the general population maintained by an independent research organisation. Reflexive thematic analysis was conducted, and data analysis was done using NVivo version 12. The results were presented in narrative format with supporting quotes. The study received ethical and regulatory clearance to be conducted in Uganda. The average age of the respondents was 28 years. Almost all respondents had some education, and most lived in rural areas. Two themes were generated, namely, 1) deficits and opportunities for VMMC, which are issues that currently hinder the uptake of VMMC but, if addressed, would lead to better demand, and 2) pivots and shifts for VMMC, which are changes that need to be made to improve the uptake of VMMC. We found that several challenges, including myths, misconceptions, health system gaps, and uncertainties about the postoperative period, hindered the uptake of VMMC. Pivots and shifts for improving the uptake of VMMC include intensifying VMMC campaigns, addressing inequities, and addressing access barriers. We concluded that several challenges, including myths and misconceptions, health system-related gaps, and uncertainties in the post-circumcision period, persist and negatively impact the scale-up of VMMC in Uganda. VMMC beneficiaries have plausible proposals for addressing challenges. The Uganda Ministry of Health should address the myths, misconceptions, health system-related gaps, and uncertainties about the postoperative period and should involve VMMC beneficiaries in reviewing interventions to address gaps.
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Affiliation(s)
| | | | - Mark Limmer
- Department of Health Research, Lancaster University, Lancaster, UK
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17
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Fu X, Franchak JM, MacNeill LA, Gunther KE, Borjon JI, Yurkovic-Harding J, Harding S, Bradshaw J, Pérez-Edgar KE. Implementing mobile eye tracking in psychological research: A practical guide. Behav Res Methods 2024:10.3758/s13428-024-02473-6. [PMID: 39147949 DOI: 10.3758/s13428-024-02473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 08/17/2024]
Abstract
Eye tracking provides direct, temporally and spatially sensitive measures of eye gaze. It can capture visual attention patterns from infancy through adulthood. However, commonly used screen-based eye tracking (SET) paradigms are limited in their depiction of how individuals process information as they interact with the environment in "real life". Mobile eye tracking (MET) records participant-perspective gaze in the context of active behavior. Recent technological developments in MET hardware enable researchers to capture egocentric vision as early as infancy and across the lifespan. However, challenges remain in MET data collection, processing, and analysis. The present paper aims to provide an introduction and practical guide to starting researchers in the field to facilitate the use of MET in psychological research with a wide range of age groups. First, we provide a general introduction to MET. Next, we briefly review MET studies in adults and children that provide new insights into attention and its roles in cognitive and socioemotional functioning. We then discuss technical issues relating to MET data collection and provide guidelines for data quality inspection, gaze annotations, data visualization, and statistical analyses. Lastly, we conclude by discussing the future directions of MET implementation. Open-source programs for MET data quality inspection, data visualization, and analysis are shared publicly.
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Affiliation(s)
- Xiaoxue Fu
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - John M Franchak
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Leigha A MacNeill
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA
| | - Kelley E Gunther
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Jeremy I Borjon
- Department of Psychology, University of Houston, Houston, TX, USA
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
- Texas Center for Learning Disorders, University of Houston, Houston, TX, USA
| | | | - Samuel Harding
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Koraly E Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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18
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Zimmerman LA, Sarria I, Kassa M, Karp C, Seme A, Shiferaw S. Identifying what contraceptive side effects women are told about during counseling using nationally representative PMA Ethiopia 2019 cross-sectional data. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002111. [PMID: 39146378 PMCID: PMC11326631 DOI: 10.1371/journal.pgph.0002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/09/2024] [Indexed: 08/17/2024]
Abstract
Despite widespread concerns about contraceptive side effects among contraceptive users, few studies explore the specific side effects women are told about during contraceptive counseling. It is thus unclear whether women receive appropriate and sufficient information on side effects they may experience. The objective of this study is to describe which specific side effects of hormonal contraception or copper IUD users are counseled on and identify relevant user characteristics associated with receipt of counseling, using nationally representative cross-sectional data from Ethiopia. Data were collected from a nationally representative sample of women between October and December 2019. Analyses were restricted to 2,039 current users of hormonal contraception (implant, injectable, pill, or emergency contraception) or the copper IUD. Descriptive analyses identified the types and number of side effects, across all methods and by the injectable, implant, and pill. Multinomial regression identified factors associated with receipt of counseling on bleeding changes only, non-bleeding changes only, or both, relative to no counseling on side effects, adjusting for method type, source, and socio-economic characteristics. Less than 10% of users were told of at least one bleeding and non-bleeding side effect. Relative to implant users, injectable and other method users were less likely to be told about bleeding changes only (aRRR: 0.65, 95% CI: 0.46-0.93 and aRRR: 0.31, 95% CI: 0.16-0.61, respectively) and users of other methods were less likely to be told about both a bleeding and non-bleeding change (aRRR: 0.43, 95% CI: 0.19-0.93). Users who received their method from a non-public source were less likely to receive counseling on any kind of side effect and nulliparous women were less likely to be told about both kinds of side effects. There is need to improve counseling on the method specific side effects on which women are counseled, particularly in the private sector.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Isabella Sarria
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Munir Kassa
- Federal Ministry of Health, Ethiopia, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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19
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Singh P, Fesshaye B, Lee C, Njogu RN, Karron RA, Limaye RJ. Maternal Immunization Decision-Making Among Pregnant and Lactating People in Kenya: A Qualitative Exploration of Peer Influences on Vaccine Decision-Making for a Future RSV Vaccine. Matern Child Health J 2024:10.1007/s10995-024-03982-8. [PMID: 39141202 DOI: 10.1007/s10995-024-03982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya. METHODS This qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach. RESULTS Participants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making. DISCUSSION Understanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance.
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Affiliation(s)
- Prachi Singh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Berhaun Fesshaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Clarice Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Rosemary N Njogu
- Jhpiego Kenya, 2nd Floor, Arlington Block, 12 Riverside, Off Riverside Drive, P.O. Box 66119-00800, Nairobi, Kenya
| | - Ruth A Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
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20
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Ngoma-Hazemba A, Chavula MP, Sichula N, Silumbwe A, Mweemba O, Mweemba M, Simpungwe MK, Phiri H, Kasengele CT, Halwiindi H, Munakampe MN, Zulu JM. Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, HIV and GBV services among adolescent girls and young women in Zambia: a qualitative study. BMC Public Health 2024; 24:2191. [PMID: 39138556 PMCID: PMC11321158 DOI: 10.1186/s12889-024-19663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia. METHODS This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis. RESULTS The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services. CONCLUSION The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population.
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Affiliation(s)
- Alice Ngoma-Hazemba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Malizgani Paul Chavula
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umea, Sweden.
| | - Noah Sichula
- Ministry of Health, Ndeke House, Haile Selassie Avenue, PO Box, 30205, Lusaka, Zambia
| | - Adam Silumbwe
- Department of Community Education and Lifelong Learning, School of Education, University of Zambia, Box 32379, Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umea, Sweden
| | - Mable Mweemba
- Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Henry Phiri
- Ministry of Health, Ndeke House, Haile Selassie Avenue, PO Box, 30205, Lusaka, Zambia
| | - Chowa Tembo Kasengele
- Ministry of Health, Ndeke House, Haile Selassie Avenue, PO Box, 30205, Lusaka, Zambia
| | - Hikabasa Halwiindi
- Ministry of Health, Ndeke House, Haile Selassie Avenue, PO Box, 30205, Lusaka, Zambia
| | - Margarate N Munakampe
- Department of Community Education and Lifelong Learning, School of Education, University of Zambia, Box 32379, Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umea, Sweden
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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Zimmerman LA, Karp C, Shiferaw S, Seme A, Bell SO. Assessing the effect of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence: evidence from PMA Ethiopia 2020 cross-sectional survey. BMJ Open 2024; 14:e077192. [PMID: 39142681 PMCID: PMC11331875 DOI: 10.1136/bmjopen-2023-077192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence. DESIGN We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement 'If I use family planning, I may have trouble getting pregnant next time I want to.' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence. RESULTS 4 in 10 women disagreed (42.3%) and 2 in 10 strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (adjusted OR (aOR) 0.65, 95% CI 0.44 to 0.97 and 0.46, 95% CI 0.46, 95% CI 0.30 to 0.70). The effect of agreeing with the statement was strongest among high parity women (aOR 0.54, 95% CI 0.30 to 0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception but only among rural women. CONCLUSIONS Efforts to address concerns around contraceptive-induced fertility impairment through the provision of comprehensive counselling and through community education or mass media campaigns are necessary, particularly among high-parity women and in rural communities. Interventions should acknowledge the possibility of delayed return to fertility for specific methods and attempt to address the root causes of concerns.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Celia Karp
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Assefa Seme
- Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Suzanne O Bell
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ogunnupebi TA, Oduselu GO, Elebiju OF, Ajani OO, Adebiyi E. In silico studies of benzothiazole derivatives as potential inhibitors of Anopheles funestus and Anopheles gambiae trehalase. FRONTIERS IN BIOINFORMATICS 2024; 4:1428539. [PMID: 39184337 PMCID: PMC11341456 DOI: 10.3389/fbinf.2024.1428539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/17/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction In malaria management, insecticides play a crucial role in targeting disease vectors. Benzothiazole derivatives have also been reported to possess insecticidal properties, among several other properties they exhibit. The female Anopheles mosquito is responsible for transmitting the malaria parasite when infected. Anopheles gambiae (Ag) and Anopheles funestus (Af) are two of the most notable Anopheles species known to spread malaria in Nigeria. Trehalase is an enzyme that breaks down trehalose. Recent research has proposed it as a viable target for inhibition since it aids in flight and stress adaptation. Methods This study aimed to investigate benzothiazole derivatives as potential inhibitors of trehalase of Anopheles funestus (AfTre) and Anopheles gambiae (AgTre) using toxicity profiling, molecular docking, and dynamic simulation for future insecticidal intervention. A total of 4,214 benzothiazole-based compounds were obtained from the PubChem database and subjected to screening against the 3D modelled structure of AfTre and AgTre. Compounds with some toxicity levels were optimised, and the obtained lead compounds were further investigated through molecular docking studies. Furthermore, the best hit was subjected to parameters such as RMSD, RMSF, SASA, Rg, and hydrogen bond to confirm its stability when in a complex with AfTre, and these parameters were compared to that of validamycin A (control ligand). Results and discussion The post-screening analysis showed binding affinities of -8.7 and -8.2 kcal/mol (compound 1), -8.2 and -7.4 kcal/mol (compound 2), compared to -6.3 and -5.1 kcal/mol (Validamycin A, a known inhibitor) against AfTre and AgTre, respectively. The molecular dynamics simulation showed that compound 1 (the best hit) had good stability when in complex with AfTre. These findings suggest that these best hits can serve as potential inhibitors for the development of novel insecticides in the control of malaria vectors.
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Affiliation(s)
- Temitope A. Ogunnupebi
- Covenant University Bio-Informatics Research Cluster (CUBRe), Covenant University, Ota, Ogun State, Nigeria
- Department of Chemistry, Covenant University, Ota, Ogun State, Nigeria
| | - Gbolahan O. Oduselu
- Covenant University Bio-Informatics Research Cluster (CUBRe), Covenant University, Ota, Ogun State, Nigeria
| | - Oluwadunni F. Elebiju
- Covenant University Bio-Informatics Research Cluster (CUBRe), Covenant University, Ota, Ogun State, Nigeria
- Department of Chemistry, Covenant University, Ota, Ogun State, Nigeria
| | - Olayinka O. Ajani
- Covenant University Bio-Informatics Research Cluster (CUBRe), Covenant University, Ota, Ogun State, Nigeria
- Department of Chemistry, Covenant University, Ota, Ogun State, Nigeria
| | - Ezekiel Adebiyi
- Covenant University Bio-Informatics Research Cluster (CUBRe), Covenant University, Ota, Ogun State, Nigeria
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- African Center of Excellence in Bioinformatics and Data Intensive Science, Makerere University, Kampala, Uganda
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Oh J, Ordoñez ELT, Velasquez E, Mejía M, Del Pilar Grazioso M, Rohloff P, Smith BA. Associating neuromotor outcomes at 12 months with wearable sensor measures collected during early infancy in rural Guatemala. Gait Posture 2024; 113:477-489. [PMID: 39126960 DOI: 10.1016/j.gaitpost.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Sensitive measures to predict neuromotor outcomes from data collected early in infancy are lacking. Measures derived from the recordings of infant movement using wearable sensors may be a useful new technique. METHODS We collected full-day leg movement of 41 infants in rural Guatemala across 3 visits between birth and 6 months of age using wearable sensors. Average leg movement rate and fuzzy entropy, a measure to describe the complexity of signals, of the leg movements' peak acceleration time series and the time series itself were derived. We tested the three measures for the predictability of infants' developmental outcome, Bayley Scales of Infant and Toddler Development III motor, language, or cognitive composite score assessed at 12 months of age. We performed quantile regressions with clustered standard errors, accounting for the multiple visits for each infant. RESULTS Fuzzy entropy was associated with the motor composite score at the 0.5 quantiles; this association was not found for the other two measures. Also, no leg movement characteristic was associated with language or cognitive composite scores. CONCLUSION We propose that the entropy of leg movement associated peak accelerations calculated from the wearable sensor data collected for a full-day can be considered as one predictor for infants' motor developmental outcome assessed with Bayley Scales of Infant and Toddler Development III at 12 months of age.
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Affiliation(s)
- Jinseok Oh
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, USA
| | | | | | | | | | - Peter Rohloff
- Wuqu' Kawoq | Maya Health Alliance, Guatemala; Division of Global Health equity, Brigham and Women's Hospital, USA.
| | - Beth A Smith
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, USA; Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, USA.
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24
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Mushtaq I, Sarwar MS, Munzoor I. A comprehensive review of Wolbachia-mediated mechanisms to control dengue virus transmission in Aedes aegypti through innate immune pathways. Front Immunol 2024; 15:1434003. [PMID: 39176079 PMCID: PMC11338905 DOI: 10.3389/fimmu.2024.1434003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/16/2024] [Indexed: 08/24/2024] Open
Abstract
The Dengue virus (DENV), primarily spread by Aedes aegypti and also by Aedes albopictus in some regions, poses significant global health risks. Alternative techniques are urgently needed because the current control mechanisms are insufficient to reduce the transmission of DENV. Introducing Wolbachia pipientis into Ae. aegypti inhibits DENV transmission, however, the underlying mechanisms are still poorly understood. Innate immune effector upregulation, the regulation of autophagy, and intracellular competition between Wolbachia and DENV for lipids are among the theories for the mechanism of inhibition. Furthermore, mainly three immune pathways Toll, IMD, and JAK/STAT are involved in the host for the suppression of the virus. These pathways are activated by Wolbachia and DENV in the host and are responsible for the upregulation and downregulation of many genes in mosquitoes, which ultimately reduces the titer of the DENV in the host. The functioning of these immune pathways depends upon the Wolbachia, host, and virus interaction. Here, we summarize the current understanding of DENV recognition by the Ae. aegypti's immune system, aiming to create a comprehensive picture of our knowledge. Additionally, we investigated how Wolbachia regulates the activation of multiple genes associated with immune priming for the reduction of DENV.
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25
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Kormos A, Nazaré L, dos Santos AA, Lanzaro GC. Practical Application of a Relationship-Based Model to Engagement for Gene-Drive Vector Control Programs. Am J Trop Med Hyg 2024; 111:341-360. [PMID: 38889708 PMCID: PMC11310621 DOI: 10.4269/ajtmh.23-0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/19/2024] [Indexed: 06/20/2024] Open
Abstract
Engagement is an important component in the advancement of gene-drive vector control research programs as developers look to transition the technology from the laboratory to the field. As research advances and engagement surrounding this novel technology is put into practice, knowledge can be gained from practical experiences and applications in the field. A relationship-based model (RBM) provides a framework for end-user development of engagement programs and strategies. The model places end users at the center of the engagement decision-making processes rather than as recipients of predetermined strategies, methods, and definitions. Successful RBM application for healthcare delivery has previously been demonstrated, and the University of California Malaria Initiative (UCMI) has applied this model to its gene-drive program in the Democratic Republic of São Tomé and Príncipe. The model emphasizes the importance of local leadership in the planning, development, and implementation of all phases of project engagement. The primary aim of this paper is to translate the model from paper to practice and provide a transparent description, using practical examples, of the UCMI program implementation of RBM at its field site. End-user development of the UCMI engagement program provides a unique approach to the development of ethical, transparent, and effective engagement strategies for malaria control programs. This paper may also serve as a reference and example for projects looking to establish an engagement program model that integrates end-user groups in the decision-making processes surrounding engagement.
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Affiliation(s)
- Ana Kormos
- Vector Genetics Laboratory, University of California, Davis, California
| | - Lodney Nazaré
- University of California Malaria Initiative, University of California, Davis, California
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Hussey H, Vreede H, Davies MA, Heekes A, Kalk E, Hardie D, van Zyl G, Naidoo M, Morden E, Bam JL, Zinyakatira N, Centner CM, Maritz J, Opie J, Chapanduka Z, Mahomed H, Smith M, Cois A, Pienaar D, Redd AD, Preiser W, Wilkinson R, Boulle A, Hsiao NY. SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income communities. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003554. [PMID: 39106267 DOI: 10.1371/journal.pgph.0003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 07/08/2024] [Indexed: 08/09/2024]
Abstract
In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can help describe and characterise the extent of the pandemic, as well as elucidate protection conferred by prior exposure. We conducted repeated cross-sectional serosurveys (July 2020 -November 2021) using residual samples from patients from Cape Town, South Africa, sent for routine laboratory studies for non-COVID-19 conditions. SARS-CoV-2 anti-nucleocapsid antibodies and linked clinical information were used to investigate: (1) seroprevalence over time and risk factors associated with seropositivity, (2) ecological comparison of seroprevalence between subdistricts, (3) case ascertainment rates, and (4) the relative protection against COVID-19 associated with seropositivity and vaccination statuses. Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.19% (95% confidence interval [CI] 37.23-41.19) in July 2020 to 67.8% (95%CI 66.31-69.25) in November 2021. Poorer communities had both higher seroprevalence and COVID-19 mortality. Only 10% of seropositive individuals had a recorded positive SARS-CoV-2 test. Using COVID-19 hospital admission and death data at the Provincial Health Data Centre, antibody positivity before the start of the Omicron BA.1 wave (28 November 2021) was strongly protective for severe disease (adjusted odds ratio [aOR] 0.15; 95%CI 0.05-0.46), with additional benefit in those who were also vaccinated (aOR 0.07, 95%CI 0.01-0.35). The high population seroprevalence in Cape Town was attained at the cost of substantial COVID-19 mortality. At the individual level, seropositivity was highly protective against subsequent infections and severe COVID-19 disease. In low-income communities, where diagnostic testing capacity is often limited, surveillance systems dependent on them will underestimate the true extent of an outbreak. Rapidly conducted seroprevalence studies can play an important role in addressing this.
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Affiliation(s)
- Hannah Hussey
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- Metro Health Services, Western Cape Government: Health, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Helena Vreede
- Division of Chemical Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Mary-Ann Davies
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Alexa Heekes
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Emma Kalk
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Diana Hardie
- National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Gert van Zyl
- National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Michelle Naidoo
- National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Erna Morden
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jamy-Lee Bam
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
| | - Nesbert Zinyakatira
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chad M Centner
- National Health Laboratory Service, Cape Town, South Africa
| | - Jean Maritz
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- PathCare Reference Laboratory, Cape Town, South Africa
| | - Jessica Opie
- National Health Laboratory Service, Cape Town, South Africa
- Division of Haematology, University of Cape Town, Cape Town, South Africa
| | - Zivanai Chapanduka
- National Health Laboratory Service, Cape Town, South Africa
- Division of Haematology, Stellenbosch University, Cape Town, South Africa
| | - Hassan Mahomed
- Metro Health Services, Western Cape Government: Health, Cape Town, South Africa
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mariette Smith
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Annibale Cois
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Pienaar
- Rural Health Services, Western Cape Government: Health, Cape Town, South Africa
| | - Andrew D Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Wolfgang Preiser
- National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Robert Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Andrew Boulle
- Health Intelligence Directorate, Western Cape Government: Health, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- National Health Laboratory Service, Cape Town, South Africa
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
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Chow JY, Geng L, Bansal S, Dickens BSL, Ng LC, Hoffmann AA, Lim JT. Evaluating quasi-experimental approaches for estimating epidemiological efficacy of non-randomised field trials: applications in Wolbachia interventions for dengue. BMC Med Res Methodol 2024; 24:170. [PMID: 39107710 PMCID: PMC11302844 DOI: 10.1186/s12874-024-02291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Wolbachia symbiosis in Aedes aegypti is an emerging biocontrol measure against dengue. However, assessing its real-world efficacy is challenging due to the non-randomised, field-based nature of most intervention studies. This research re-evaluates the spatial-temporal impact of Wolbachia interventions on dengue incidence using a large battery of quasi-experimental methods and assesses each method's validity. METHODS A systematic search for Wolbachia intervention data was conducted via PUBMED. Efficacy was reassessed using commonly-used quasi-experimental approaches with extensive robustness checks, including geospatial placebo tests and a simulation study. Intervention efficacies across multiple study sites were computed using high-resolution aggregations to examine heterogeneities across sites and study periods. We further designed a stochastic simulation framework to assess the methods' ability to estimate intervention efficacies (IE). RESULTS Wolbachia interventions in Singapore, Malaysia, and Brazil significantly decreased dengue incidence, with reductions ranging from 48.17% to 69.19%. IEs varied with location and duration. Malaysia showed increasing efficacy over time, while Brazil exhibited initial success with subsequent decline, hinting at operational challenges. Singapore's strategy was highly effective despite partial saturation. Simulations identified Synthetic Control Methods (SCM) and its variant, count Synthetic Control Method (cSCM), as superior in precision, with the smallest percentage errors in efficacy estimation. These methods also demonstrated robustness in placebo tests. CONCLUSIONS Wolbachia interventions exhibit consistent protective effects against dengue. SCM and cSCM provided the most precise and robust estimates of IEs, validated across simulated and real-world settings.
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Affiliation(s)
- Jo Yi Chow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore.
| | - Lin Geng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
| | - Somya Bansal
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Lee Ching Ng
- National Environment Agency, 11, Biopolis Way, #06-05/08, Helios Block, Singapore, 138667, Singapore
| | - Ary Anthony Hoffmann
- Pest and Environmental Research Group, Bio21 Institute, University of Melbourne, Melbourne, Vic, 3010, Australia
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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Lin H, Guo S, Zheng Q, Liu X, Hu A, Zeng J, Liu G. Couples' perceptions and experience of smartphone-assisted CenteringPregnancy model in southeast of China: a dyadic analysis of qualitative study. BMJ Open 2024; 14:e079121. [PMID: 39107027 PMCID: PMC11308902 DOI: 10.1136/bmjopen-2023-079121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 07/16/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES The objectives of this study are to describe couples' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model. DESIGN This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis. SETTING This study was conducted in two pilot prenatal clinics in southern China. PARTICIPANTS A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023. RESULTS The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy. CONCLUSIONS CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted.
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Affiliation(s)
- Huimin Lin
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shengbin Guo
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | | | - Xiuwu Liu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Anfen Hu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jing Zeng
- Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Guihua Liu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
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Boateng D, Oppong FB, Senkyire EK, Logo DD. Spatial analysis and factors associated with low birth weight in Ghana using data from the 2017 Ghana Maternal Health Survey: spatial and multilevel analysis. BMJ Open 2024; 14:e083904. [PMID: 39107031 PMCID: PMC11308880 DOI: 10.1136/bmjopen-2024-083904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE Low birth weight (LBW) is an important indicator of newborn health and can have long-term implications for a child's development. Spatial exploratory analysis provides a toolkit to gain insight into inequalities in LBW. Few studies in Ghana have explored the spatial distribution of LBW to understand the extent of the problem geographically. This study explores individual and cluster-level distributions of LBW using spatial exploration components for common determinants from nationally representative survey data. DESIGN We used data from the 2017 Ghana Maternal Health Survey and conducted individual-level and cluster-level analyses of LBW with place and zone of residence in both bivariate and multivariate analyses. By incorporating spatial and survey designs methodology, logistic and Poisson regression models were used to model LBW. SETTING Ghana. PARTICIPANTS A total of 4127 women aged between 15 and 49 years were included in the individual-level analysis and 864 clusters corresponding to birth weight. PRIMARY AND SECONDARY OUTCOME MEASURES Individual and cluster-level distribution for LBW using spatial components for common determinants. RESULTS In the individual-level analysis, place and zone of residence were significantly associated with LBW in the bivariate model but not in a multivariate model. Hotspot analysis indicated the presence of LBW clusters in the middle and northern zones of Ghana. Compared with rural areas, clusters in urban areas had significantly lower LBW (p=0.017). Clusters in the northern zone were significantly associated with higher LBW (p=0.018) compared with the coastal zones. CONCLUSION Our findings from choropleth hotspot maps suggest LBW clusters in Ghana's northern and middle zones. Disparities between the rural and urban continuum require specific attention to bridge the healthcare system gap for Ghana's northern and middle zones.
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Cargnin Faccin F, Cáceres CJ, Gay LC, Seibert B, van Bentem N, Rodriguez LA, Soares Fraiha AL, Cardenas M, Geiger G, Ortiz L, Carnaccini S, Kapczynski DR, Rajao DS, Perez DR. Mass vaccination with reassortment-impaired live H9N2 avian influenza vaccine. NPJ Vaccines 2024; 9:136. [PMID: 39097573 PMCID: PMC11297921 DOI: 10.1038/s41541-024-00923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/12/2024] [Indexed: 08/05/2024] Open
Abstract
Avian influenza poses a severe threat to poultry production and global food security, prompting the development of vaccination programs in numerous countries. Modified live virus (MLV) vaccines, with their potential for mass application, offer a distinct advantage over existing options. However, concerns surrounding reversion, recombination, and unintended transmission have hindered the progress of MLV development for avian influenza in poultry. To address these concerns, we engineered reassortment-impaired, non-transmissible, safe, immunogenic, and protective MLVs through the rearrangement of internal gene segments and additional modifications to the surface gene segments HA and NA. The unique peptide marker aspartic acid-arginine-proline-alanine-valine-isoleucine-alanine-asparragine (DRPAVIAN) was incorporated into HA, while NA was modified to encode the chicken interleukin-18 (ckIL18) gene (MLV-H9N2-IL). In vitro, the MLV-H9N2 and MLV-H9N2-IL candidates demonstrated stability and virus titers comparable to the wild-type H9N2 strain. In chickens, the MLV-H9N2 and MLV-H9N2-IL candidates did not transmit via direct contact. Co-infection studies with wild-type virus confirmed that the altered HA and NA segments exhibited fitness disadvantages and did not reassort. Vaccinated chickens showed no clinical signs upon vaccination, all seroconverted, and the inclusion of ckIL18 in the MLV-H9N2-IL vaccine enhanced neutralizing antibody production. A significant decrease in viral loads post-challenge underscored the protective effect of the MLVs. The MLV-H9N2-IL vaccine, administered via drinking water, proved immunogenic in chickens in a dose-dependent manner, generating protective levels of neutralizing antibodies upon aggressive homologous virus challenge. In summary, this study lays the groundwork for safe MLVs against avian influenza suitable for mass vaccination efforts.
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Affiliation(s)
- Flavio Cargnin Faccin
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - C Joaquin Cáceres
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - L Claire Gay
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Brittany Seibert
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nick van Bentem
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Division of Farm Animal Health, Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Luis A Rodriguez
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ana Luiza Soares Fraiha
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais, Belo, Horizonte, Minas Gerais, Brazil
| | - Matias Cardenas
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Ginger Geiger
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Lucia Ortiz
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Silvia Carnaccini
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Darrell R Kapczynski
- Exotic and Emerging Avian Viral Disease Research Unit, Southeast Poultry Research Laboratory, U.S. National Poultry Research Center, Agricultural Research Service, USDA, Athens, GA, USA
| | - Daniela S Rajao
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Daniel R Perez
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
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Donald PR, Kaufmann SHE, Schaub D, Thee S, Lange C. Carl Flügge, one of the last holistic hygienists and discoverer of droplet transmission of infectious diseases. Med Microbiol Immunol 2024; 213:17. [PMID: 39093331 PMCID: PMC11297070 DOI: 10.1007/s00430-024-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
Carl Flügge is best known for the promotion of studies demonstrating the transmission of all manner of infections, but particularly tuberculosis, by coughed droplets. But it is seldom recognised that Flügge was also influential in a number of other fields comprising the practice of hygiene. One-hundred years following his death in 1923, we review literature related to the studies of Flügge and his colleagues and students and illustrate the particular emphasis he laid upon the environment within which disease and its transmission might be fostered or prevented, embracing and studying aspects essential to the health of any community ranging from fundamental microbiology in the laboratory to subjects as disparate as housing, clean water supply, nutrition, sanitation, socio-economic circumstances and climate. Very early in his career he promoted breast feeding for the prevention of seasonal gastro-enteritis and later the sheltering of cough as a means of preventing the transmission of infected respiratory droplets, not only as regards tuberculosis, but also concerning all manner of other respiratory infections. By the time of Flügge's death the complexification of available scientific methodologies comprising hygiene made it difficult for any individual to comprehend and study the wide range of hygiene-related subjects such as Flügge did. Carl Flügge was one of the last holistic hygienists and an originator of the study of environmental health as a pillar of hygiene.
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Affiliation(s)
- Peter R Donald
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, Western Cape Province, South Africa.
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Hagler Institute for Advanced Study, Texas A&M University, College Station, USA
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Dagmar Schaub
- German Center for Infection Research (DZIF), Partner Site Hamburg- Lübeck-Borstel-Riems, Lübeck, Germany
- Department of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Lange
- German Center for Infection Research (DZIF), Partner Site Hamburg- Lübeck-Borstel-Riems, Lübeck, Germany
- Department of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Baylor College of Medicine and Texas Childrens' Hospital, Houston, TX, USA
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Moucheraud C, Ochieng E, Ogutu V, Sudhinaraset M, Szilagyi PG, Hoffman RM, Glenn B, Golub G, Njomo D. Trust in health workers and patient-centeredness of care were strongest factors associated with vaccination for Kenyan children born between 2017-2022. Vaccine X 2024; 19:100523. [PMID: 39070930 PMCID: PMC11283225 DOI: 10.1016/j.jvacx.2024.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/03/2024] [Indexed: 07/30/2024] Open
Abstract
Objective Although vaccination confidence is declining globally, there is little detailed information from low- and middle-income countries about factors influencing routine vaccination behavior in these contexts. Methods In mid-2022, we surveyed people who gave birth in Kenya between 2017-2022, and asked them about their children's vaccination history and about hypothesized correlates of vaccination per the Behavioural and Social Drivers of Vaccination model. Results Of 873 children in this sample, 117 (13%) were under-vaccinated (i.e., delayed or missing vaccine dose(s)) - and under-vaccination was more common among births during the COVID-19 pandemic (2020-2022) versus pre-pandemic (2017-2019). In multi-level multivariable models, children of respondents who expressed concerns about serious side effects from vaccines had significantly higher odds of missed vaccine dose(s) (aOR 2.06, 95 % CI 1.14-3.72), and there was a strong association between having more safety concerns now versus before the COVID-19 pandemic (aOR missed dose(s) 4.44, 95 % CI 1.71-11.51; aOR under-vaccination 3.03, 95 % CI 1.28-7.19). People with greater trust in health workers had lower odds of having a child with missed vaccine dose(s) (aOR 0.85, 95 % CI 0.75-0.97). People who reported higher patient-centered quality of vaccination care had much lower odds of having children with delayed or missed vaccine dose(s) (aOR missed dose(s) 0.14, 95 % CI 0.04-0.58; aOR under-vaccination 0.27, 95 % CI 0.10-0.79). Conclusions These findings highlight potential strategies to improve vaccine coverage: greater focus on patient-centered quality of care, training healthcare workers on how to address safety concerns about vaccines, and building trust in the health care system and in health workers.
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Affiliation(s)
- Corrina Moucheraud
- New York University, School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Eric Ochieng
- Innovations for Poverty Action Kenya, P.O. Box 72427-00200, Nairobi, Kenya
| | - Vitalis Ogutu
- Innovations for Poverty Action Kenya, P.O. Box 72427-00200, Nairobi, Kenya
| | - May Sudhinaraset
- University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095 USA
| | - Peter G. Szilagyi
- University of California Los Angeles, David Geffen School of Medicine, 855 Tiverton Dr, Los Angeles, CA 90024 USA
| | - Risa M. Hoffman
- University of California Los Angeles, David Geffen School of Medicine, 855 Tiverton Dr, Los Angeles, CA 90024 USA
| | - Beth Glenn
- University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095 USA
| | - Ginger Golub
- Innovations for Poverty Action Kenya, P.O. Box 72427-00200, Nairobi, Kenya
| | - Doris Njomo
- Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
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Verde Hashim C, Llewellyn E, Wood R, Brett T, Chinyanga T, Webb K, Segal K. Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre-exposure prophylaxis, in an expanding HIV prevention landscape. J Int AIDS Soc 2024; 27:e26346. [PMID: 39148275 PMCID: PMC11327274 DOI: 10.1002/jia2.26346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/24/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP. METHODS Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage. RESULTS Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels. CONCLUSIONS The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.
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Affiliation(s)
| | | | - Rob Wood
- Halcyon Consultancy, Nairobi, Kenya
| | | | - Tinashe Chinyanga
- The Organization for Public Health Interventions and Development (OPHID), Harare, Zimbabwe
| | - Karen Webb
- The Organization for Public Health Interventions and Development (OPHID), Harare, Zimbabwe
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de Souza WM, Weaver SC. Effects of climate change and human activities on vector-borne diseases. Nat Rev Microbiol 2024; 22:476-491. [PMID: 38486116 DOI: 10.1038/s41579-024-01026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
Vector-borne diseases are transmitted by haematophagous arthropods (for example, mosquitoes, ticks and sandflies) to humans and wild and domestic animals, with the largest burden on global public health disproportionately affecting people in tropical and subtropical areas. Because vectors are ectothermic, climate and weather alterations (for example, temperature, rainfall and humidity) can affect their reproduction, survival, geographic distribution and, consequently, ability to transmit pathogens. However, the effects of climate change on vector-borne diseases can be multifaceted and complex, sometimes with ambiguous consequences. In this Review, we discuss the potential effects of climate change, weather and other anthropogenic factors, including land use, human mobility and behaviour, as possible contributors to the redistribution of vectors and spread of vector-borne diseases worldwide.
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Affiliation(s)
- William M de Souza
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY, USA
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX, USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
- Global Virus Network, Baltimore, MD, USA
| | - Scott C Weaver
- World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX, USA.
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
- Global Virus Network, Baltimore, MD, USA.
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Saldanha I, Lea R, Manangwa O, Garrod G, Haines LR, Acosta-Serrano Á, Auty H, Betson M, Lord JS, Morrison LJ, Mramba F, Torr SJ, Cunningham LJ. Caught in a trap: DNA contamination in tsetse xenomonitoring can lead to over-estimates of Trypanosoma brucei infection. PLoS Negl Trop Dis 2024; 18:e0012095. [PMID: 39133740 PMCID: PMC11341098 DOI: 10.1371/journal.pntd.0012095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/22/2024] [Accepted: 07/26/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Tsetse flies (Glossina sp.) are vectors of Trypanosoma brucei subspecies that cause human African trypanosomiasis (HAT). Capturing and screening tsetse is critical for HAT surveillance. Classically, tsetse have been microscopically analysed to identify trypanosomes, but this is increasingly replaced with molecular xenomonitoring. Nonetheless, sensitive T. brucei-detection assays, such as TBR-PCR, are vulnerable to DNA cross-contamination. This may occur at capture, when often multiple live tsetse are retained temporarily in the cage of a trap. This study set out to determine whether infected tsetse can contaminate naïve tsetse with T. brucei DNA via faeces when co-housed. METHODOLOGY/PRINCIPLE FINDINGS Insectary-reared teneral G. morsitans morsitans were fed an infectious T. b. brucei-spiked bloodmeal. At 19 days post-infection, infected and naïve tsetse were caged together in the following ratios: (T1) 9:3, (T2) 6:6 (T3) 1:11 and a control (C0) 0:12 in triplicate. Following 24-hour incubation, DNA was extracted from each fly and screened for parasite DNA presence using PCR and qPCR. All insectary-reared infected flies were positive for T. brucei DNA using TBR-qPCR. However, naïve tsetse also tested positive. Even at a ratio of 1 infected to 11 naïve flies, 91% of naïve tsetse gave positive TBR-qPCR results. Furthermore, the quantity of T. brucei DNA detected in naïve tsetse was significantly correlated with cage infection ratio. With evidence of cross-contamination, field-caught tsetse from Tanzania were then assessed using the same screening protocol. End-point TBR-PCR predicted a sample population prevalence of 24.8%. Using qPCR and Cq cut-offs optimised on insectary-reared flies, we estimated that prevalence was 0.5% (95% confidence interval [0.36, 0.73]). CONCLUSIONS/SIGNIFICANCE Our results show that infected tsetse can contaminate naïve flies with T. brucei DNA when co-caged, and that the level of contamination can be extensive. Whilst simple PCR may overestimate infection prevalence, quantitative PCR offers a means of eliminating false positives.
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Affiliation(s)
- Isabel Saldanha
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel Lea
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Oliver Manangwa
- Vector and Vector-borne Diseases Research Institute, Tanga, Tanzania
| | - Gala Garrod
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lee R. Haines
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Álvaro Acosta-Serrano
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Harriet Auty
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Martha Betson
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Jennifer S. Lord
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Liam J. Morrison
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Furaha Mramba
- Vector and Vector-borne Diseases Research Institute, Tanga, Tanzania
| | - Stephen J. Torr
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Bailey JG, Mossenson AI, Whynot S, Nyirigira G, Gower S, Livingston P. A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings. Anesth Analg 2024; 139:375-384. [PMID: 39008977 DOI: 10.1213/ane.0000000000006870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. METHODS This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. RESULTS Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. CONCLUSIONS Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.
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Affiliation(s)
- Jonathan G Bailey
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - Adam I Mossenson
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
- St John of God Midland Public and Private Hospitals, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Gaston Nyirigira
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Shelley Gower
- Curtin School of Nursing, Curtin University, Perth, Australia
| | - Patricia Livingston
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
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Minnis AM, Agot K, Hartmann M, Otticha S, Montgomery ET, Roberts ST. Feasibility and Acceptability of the Novel Tu'Washindi Intervention to Increase PrEP Use among Adolescent Girls and Young Women in Siaya County, Kenya. AIDS Behav 2024; 28:2695-2707. [PMID: 38836985 DOI: 10.1007/s10461-024-04390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
The Tu'Washindi intervention addressed intimate partner violence (IPV) and relationship dynamics to increase PrEP use among adolescent girls and young women (AGYW) in Siaya County, Kenya. We evaluated feasibility and acceptability in a cluster-randomized trial in six DREAMS Safe Spaces. The multilevel intervention, delivered over 6 months, included three components delivered by DREAMS staff with support from the study team: an 8-session structured support club; community sensitization of male partners; and a couples PrEP education and health fair ("Buddy Day"). Feasibility and acceptability assessments included implementation process measures, questionnaires, and focus group discussions with AGYWs and post-intervention questionnaires with intervention providers. The study included 103 AGYWs aged 17 to 24 (N = 49 intervention), with 97% retention. Median age was 22, 54% were married, and 84% were mothers. At enrollment, 45% used PrEP and 61% reported lifetime IPV. All intervention participants attended at least one support club session (mean = 5.2 of 8) and 90% attended Buddy Day. At 6 months, most participants perceived Tu'Washindi to be effective: all agreed (with 54% reporting "strongly agree") that the intervention improved partner communication and 60% agreed they were better able to gain partner support for their PrEP use. Providers believed the intervention resonated with community values. Tu'Washindi was highly acceptable and feasible and it was perceived by AGYW participants and providers as being effective in improving partner relationships and supporting PrEP use.
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Affiliation(s)
- Alexandra M Minnis
- Research Triangle Park, Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Miriam Hartmann
- Research Triangle Park, Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Sophie Otticha
- Impact Research and Development Organization, Kisumu, Kenya
| | - Elizabeth T Montgomery
- Research Triangle Park, Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | - Sarah T Roberts
- Research Triangle Park, Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
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Nam Y, Kim J, Jung SH, Woerner J, Suh EH, Lee DG, Shivakumar M, Lee ME, Kim D. Harnessing Artificial Intelligence in Multimodal Omics Data Integration: Paving the Path for the Next Frontier in Precision Medicine. Annu Rev Biomed Data Sci 2024; 7:225-250. [PMID: 38768397 DOI: 10.1146/annurev-biodatasci-102523-103801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The integration of multiomics data with detailed phenotypic insights from electronic health records marks a paradigm shift in biomedical research, offering unparalleled holistic views into health and disease pathways. This review delineates the current landscape of multimodal omics data integration, emphasizing its transformative potential in generating a comprehensive understanding of complex biological systems. We explore robust methodologies for data integration, ranging from concatenation-based to transformation-based and network-based strategies, designed to harness the intricate nuances of diverse data types. Our discussion extends from incorporating large-scale population biobanks to dissecting high-dimensional omics layers at the single-cell level. The review underscores the emerging role of large language models in artificial intelligence, anticipating their influence as a near-future pivot in data integration approaches. Highlighting both achievements and hurdles, we advocate for a concerted effort toward sophisticated integration models, fortifying the foundation for groundbreaking discoveries in precision medicine.
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Affiliation(s)
- Yonghyun Nam
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Jaesik Kim
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sang-Hyuk Jung
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Jakob Woerner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Erica H Suh
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Dong-Gi Lee
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Manu Shivakumar
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Matthew E Lee
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Dokyoon Kim
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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Li J, Ulloa GM, Mayor P, Santolalla Robles ML, Greenwood AD. Nucleic acid degradation after long-term dried blood spot storage. Mol Ecol Resour 2024; 24:e13979. [PMID: 38780145 DOI: 10.1111/1755-0998.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Collecting and preserving biological samples in the field, particularly in remote areas in tropical forests, prior to laboratory analysis is challenging. Blood samples in many cases are used for nucleic acid-based species determination, genomics or pathogen research. In most cases, maintaining a cold chain is impossible and samples remain at ambient temperature for extended periods of time before controlled storage conditions become available. Dried blood spot (DBS) storage, blood stored on cellulose-based paper, has been widely applied to facilitate sample collection and preservation in the field for decades. However, it is unclear how long-term storage on this substrate affects nucleic acid concentration and integrity. We analysed nucleic acid quality from DBS stored on Whatman filter paper no. 3 and FTA cards for up to 15 years in comparison to cold-chain stored samples using four nucleic acid extraction methods. We examined the ability to identify viral sequences from samples of 12 free-ranging primates in the Amazon forest, using targeted hybridization capture, and determined if mitochondrial genomes could be retrieved. The results suggest that even after extended periods of storage, DBS will be suitable for some genomic applications but may be of limited use for viral pathogen research, particularly RNA viruses.
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Affiliation(s)
- Juan Li
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), Berlin, Germany
| | - Gabriela M Ulloa
- Programa de Pós-Graduação em Saúde e Produção Animal na Amazônia, Universidade Federal Rural da Amazônia (UFRA), Belém, Pará, Brazil
- Grupo de Enfermedades Infecciosas Re-emergentes, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Pedro Mayor
- Programa de Pós-Graduação em Saúde e Produção Animal na Amazônia, Universidade Federal Rural da Amazônia (UFRA), Belém, Pará, Brazil
- ComFauna, Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos, Peru
- Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Meddly L Santolalla Robles
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alex D Greenwood
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), Berlin, Germany
- School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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Momin MAM, Farkas D, Hindle M, Hall F, DiBlasi RM, Longest W. Development of a New Dry Powder Aerosol Synthetic Lung Surfactant Product for Neonatal Respiratory Distress Syndrome (RDS) - Part I: In Vitro Testing and Characterization. Pharm Res 2024; 41:1703-1723. [PMID: 39112775 DOI: 10.1007/s11095-024-03740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/03/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Improving the deep lung delivery of aerosol surfactant therapy (AST) with a dry powder formulation may enable significant reductions in dose while providing improved efficacy. The objective of Part I of this two-part study was to present the development of a new dry powder aerosol synthetic lung surfactant (SLS) product and to characterize performance based on aerosol formation and realistic in vitro airway testing leading to aerosol delivery recommendations for subsequent in vivo animal model experiments. METHODS A new micrometer-sized SLS excipient enhanced growth (EEG) dry powder formulation was produced via spray drying and aerosolized using a positive-pressure air-jet dry powder inhaler (DPI) intended for aerosol delivery directly to intubated infants with respiratory distress syndrome (RDS) or infant-size test animals. RESULTS The best-case design (D2) of the air-jet DPI was capable of high emitted dose (> 80% of loaded) and formed a < 2 µm mass median aerodynamic diameter (MMAD) aerosol, but was limited to ≤ 20 mg mass loadings. Testing with a realistic in vitro rabbit model indicated that over half of the loaded dose could penetrate into the lower lung regions. Using the characterization data, a dose delivery protocol was designed in which a 60 mg total loaded dose would be administered and deliver an approximate lung dose of 14.7-17.7 mg phospholipids/kg with a total aerosol delivery period < 5 min. CONCLUSIONS A high-efficiency aerosol SLS product was designed and tested that may enable an order of magnitude reduction in administered phospholipid dose, and provide rapid aerosol administration to infants with RDS.
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Affiliation(s)
- Mohammad A M Momin
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dale Farkas
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, Virginia, 23284-3015, USA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Felicia Hall
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert M DiBlasi
- Center for Respiratory Biology and Therapeutics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Worth Longest
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, Virginia, USA.
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, Virginia, 23284-3015, USA.
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Muwanga VM, Mendelsohn SC, Leukes V, Stanley K, Mbandi SK, Erasmus M, Flinn M, Fisher TL, Raphela R, Bilek N, Malherbe ST, Tromp G, Van Der Spuy G, Walzl G, Chegou NN, Scriba TJ. Blood transcriptomic signatures for symptomatic tuberculosis in an African multicohort study. Eur Respir J 2024; 64:2400153. [PMID: 38964778 PMCID: PMC11325265 DOI: 10.1183/13993003.00153-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/12/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Multiple host blood transcriptional signatures have been developed as non-sputum triage tests for tuberculosis (TB). We aimed to compare the diagnostic performance of 20 blood transcriptomic TB signatures for differentiating between symptomatic patients who have TB versus other respiratory diseases (ORD). METHODS As part of a nested case-control study, individuals presenting with respiratory symptoms at primary healthcare clinics in Ethiopia, Malawi, Namibia, Uganda, South Africa and The Gambia were enrolled. TB was diagnosed based on clinical, microbiological and radiological findings. Transcriptomic signatures were measured in whole blood using microfluidic real-time quantitative PCR. Diagnostic performance was benchmarked against the World Health Organization Target Product Profile (TPP) for a non-sputum TB triage test. RESULTS Among 579 participants, 158 had definite, microbiologically confirmed TB, 32 had probable TB, while 389 participants had ORD. Nine signatures differentiated between ORD and TB with equivalent performance (Satproedprai7: area under the curve 0.83 (95% CI 0.79-0.87); Jacobsen3: 0.83 (95% CI 0.79-0.86); Suliman2: 0.82 (95% CI 0.78-0.86); Roe1: 0.82 (95% CI 0.78-0.86); Kaforou22: 0.82 (95% CI 0.78-0.86); Sambarey10: 0.81 (95% CI 0.77-0.85); Duffy9: 0.81 (95% CI 0.76-0.86); Gliddon3: 0.8 (95% CI 0.75-0.85); Suliman4 0.79 (95% CI 0.75-0.84)). Benchmarked against a 90% sensitivity, these signatures achieved specificities between 44% (95% CI 38-49%) and 54% (95% CI 49-59%), not meeting the TPP criteria. Signature scores significantly varied by HIV status and country. In country-specific analyses, several signatures, such as Satproedprai7 and Penn-Nicholson6, met the minimal TPP criteria for a triage test in Ethiopia, Malawi and South Africa. CONCLUSION No signatures met the TPP criteria in a pooled analysis of all countries, but several signatures met the minimum criteria for a non-sputum TB triage test in some countries.
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Affiliation(s)
- Vanessa Mwebaza Muwanga
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Simon C Mendelsohn
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Vinzeigh Leukes
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kim Stanley
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Mzwandile Erasmus
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Marika Flinn
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tarryn-Lee Fisher
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rodney Raphela
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Nicole Bilek
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Stephanus T Malherbe
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerard Tromp
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gian Van Der Spuy
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Walzl
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Novel N Chegou
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
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Moulton JE, Botfield JR, Subasinghe AK, Withanage NN, Mazza D. Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review. J Clin Nurs 2024; 33:2971-3017. [PMID: 38500016 DOI: 10.1111/jocn.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
AIM To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION The study protocol is published in BJGP Open (Moulton et al., 2022).
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Asvini K Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Nishadi Nethmini Withanage
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Chu Y, Marston M, Dube A, Festo C, Geubbels E, Gregson S, Herbst K, Kabudula C, Kahn K, Lutalo T, Moorhouse L, Newton R, Nyamukapa C, Makanga R, Slaymaker E, Urassa M, Ziraba A, Calvert C, Clark SJ. Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995-2019: a multi-country surveillance study of verbal autopsy data. Lancet Glob Health 2024; 12:e1278-e1287. [PMID: 39030059 DOI: 10.1016/s2214-109x(24)00171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to little empirical data on causes of death in the region. We aimed to use verbal autopsy data to provide comparative, population-based estimates of cause-specific mortality among adolescents and adults in eastern and southern Africa. METHODS In this surveillance study, we harmonised verbal autopsy and residency data from nine health and demographic surveillance system (HDSS) sites in Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe, each with variable coverage from Jan 1, 1995, to Dec 31, 2019. We included all deaths to adolescents and adults aged 12 or over that were residents of the study sites and had a verbal autopsy conducted. InSilicoVA, a probabilistic model, was used to assign cause of death on the basis of the signs and symptoms reported in the verbal autopsy. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods. FINDINGS 52 484 deaths and 5 157 802 person-years were reported among 1 071 913 individuals across the nine sites during the study period. 47 961 (91·4%) deaths had a verbal autopsy, of which 46 570 (97·1%) were assigned a cause of death. All-cause mortality generally decreased across the HDSS sites during this period, particularly for adults aged 20-59 years. In many of the HDSS sites, these decreases were driven by reductions in HIV and tuberculosis-related deaths. In 2010-14, the top causes of death were: road traffic accidents, HIV or tuberculosis, and meningitis or sepsis in adolescents (12-19 years); HIV or tuberculosis in adults aged 20-59 years; and neoplasms and cardiovascular disease in adults aged 60 years and older. There was greater between-HDSS and between-sex variation in causes of death for adolescents compared with adults. INTERPRETATION This study shows progress in reducing mortality across eastern and southern Africa but also highlights age, sex, within-HDSS, and between-HDSS differences in causes of adolescent and adult deaths. These findings highlight the importance of detailed local data to inform health needs to ensure continued improvements in survival. FUNDING National Institute of Child Health and Human Development of the US National Institutes of Health.
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Affiliation(s)
- Yue Chu
- Department of Sociology, The Ohio State University, Columbus, OH, USA; Institute for Population Research, The Ohio State University, Columbus, OH, USA; Translational Data Analytics Institute, The Ohio State University, Columbus, OH, USA.
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Charles Festo
- Health System, Impact Evaluation and Policy Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Eveline Geubbels
- Health System, Impact Evaluation and Policy Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Durban, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Louisa Moorhouse
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Constance Nyamukapa
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ronald Makanga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Urassa
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, OH, USA; Institute for Population Research, The Ohio State University, Columbus, OH, USA; Translational Data Analytics Institute, The Ohio State University, Columbus, OH, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Hollingsworth BD, Cho C, Vella M, Roh H, Sass J, Lloyd AL, Brown ZS. Economic optimization of Wolbachia-infected Aedes aegypti release to prevent dengue. PEST MANAGEMENT SCIENCE 2024; 80:3829-3838. [PMID: 38507220 DOI: 10.1002/ps.8086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Dengue virus, primarily transmitted by the Aedes aegypti mosquito, is a major public health concern affecting ≈3.83 billion people worldwide. Recent releases of Wolbachia-transinfected Ae. aegypti in several cities worldwide have shown that it can reduce dengue transmission. However, these releases are costly, and, to date, no framework has been proposed for determining economically optimal release strategies that account for both costs associated with disease risk and releases. RESULTS We present a flexible stochastic dynamic programming framework for determining optimal release schedules for Wolbachia-transinfected mosquitoes that balances the cost of dengue infection with the costs of rearing and releasing transinfected mosquitoes. Using an ordinary differential equation model of Wolbachia and dengue in a hypothetical city loosely describing areas at risk of new dengue epidemics, we determined that an all-or-nothing release strategy that quickly brings Wolbachia to fixation is often the optimal solution. Based on this, we examined the optimal facility size, finding that it was inelastic with respect to the mosquito population size, with a 100% increase in population size resulting in a 50-67% increase in optimal facility size. Furthermore, we found that these results are robust to mosquito life-history parameters and are mostly determined by the mosquito population size and the fitness costs associated with Wolbachia. CONCLUSIONS These results reinforce that Wolbachia-transinfected mosquitoes can reduce the cost of dengue epidemics. Furthermore, they emphasize the importance of determining the size of the target population and fitness costs associated with Wolbachia before releases occur. © 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Brandon D Hollingsworth
- Department of Entomology, Cornell University, Ithaca, NY, USA
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, NC, USA
| | - Chanheung Cho
- Department of Agricultural and Resource Economics, North Carolina State University, Raleigh, NC, USA
| | - Michael Vella
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, NC, USA
| | - Hyeongyul Roh
- Department of Agricultural and Resource Economics, North Carolina State University, Raleigh, NC, USA
| | - Julian Sass
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, NC, USA
| | - Alun L Lloyd
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, NC, USA
| | - Zachary S Brown
- Department of Agricultural and Resource Economics, North Carolina State University, Raleigh, NC, USA
- Genetic Engineering and Society Center, North Carolina State University, Raleigh, NC, USA
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Lin YH, Joubert DA, Kaeser S, Dowd C, Germann J, Khalid A, Denton JA, Retski K, Tavui A, Simmons CP, O'Neill SL, Gilles JRL. Field deployment of Wolbachia-infected Aedes aegypti using uncrewed aerial vehicle. Sci Robot 2024; 9:eadk7913. [PMID: 39083575 DOI: 10.1126/scirobotics.adk7913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 07/05/2024] [Indexed: 08/02/2024]
Abstract
Over the past 50 years, there has been a marked increase in diseases like dengue fever, chikungunya, and Zika. The World Mosquito Program (WMP) has developed an approach that, instead of attempting to eliminate vector species, introduces Wolbachia into native Aedes aegypti populations through the release of Wolbachia-infected mosquitoes. Using this approach, a randomized controlled study recently demonstrated a 77% reduction in dengue across a treatment area within Yogyakarta, Indonesia. Existing release methods use the ground-based release of mosquito eggs or adults that are labor-intensive, are logistically challenging to scale up, and can be restrictive in areas where staff safety is a concern. To overcome these limitations, we developed a fully automated mosquito dosing release system that released smaller cohorts of mosquitoes over a wide area and integrated it into an uncrewed aerial vehicle. We established the effectiveness of this system using an aerial mark, release, and recapture approach. We then demonstrated that using only the aerial release method, we can establish Wolbachia infection in a naive Ae. aegypti population. In both cases, the use of aerial releases demonstrated comparable outcomes to ground-based releases without the required labor or risk. These two trials demonstrated the feasibility of using an aerial release approach for large-scale mosquito releases.
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Affiliation(s)
- Ya-Hsun Lin
- World Mosquito Program, Melbourne, VIC, Australia
| | | | | | | | | | - Anam Khalid
- World Mosquito Program, Melbourne, VIC, Australia
| | | | - Kate Retski
- World Mosquito Program, Melbourne, VIC, Australia
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Crawford JE. Virus-blocking mosquitoes take flight in the fight against dengue. Sci Robot 2024; 9:eadr0224. [PMID: 39083579 DOI: 10.1126/scirobotics.adr0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024]
Abstract
Drone-based mosquito releases facilitate the introduction of dengue-blocking bacteria in wild mosquito populations.
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Damtew SA, Gidey MY, Fantaye FT, Atnafu NT, Kassa BA, Gebrekidan HG, Bekuma TT, Amogne A, Sene KM, Demissie TD. Emotional Fertility Intention and its correlates in Ethiopia among married contraceptive user women: using linked community and health facility data from performance monitoring for action; a generalized ordered logistics regression modeling. BMC Public Health 2024; 24:2049. [PMID: 39080566 PMCID: PMC11290273 DOI: 10.1186/s12889-024-19416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country's population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility. METHODS Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant's characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. RESULTS The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23). CONCLUSION Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.
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Affiliation(s)
- Solomon Abrha Damtew
- Department of Epidemiology and Biostatistics, School of Public Health,, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | | | | | - Niguse Tadele Atnafu
- Adult Health Nursing, School of Nursing and Midwifery, Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Aynaw Amogne
- PMA Project Addis Ababa University, Addis Ababa, Ethiopia
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Resnik DB. Biosafety, biosecurity, and bioethics. Monash Bioeth Rev 2024:10.1007/s40592-024-00204-3. [PMID: 39078602 DOI: 10.1007/s40592-024-00204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/31/2024]
Abstract
The COVID-19 pandemic has highlighted the importance of biosafety in the biomedical sciences. While it is often assumed that biosafety is a purely technical matter that has little to do with philosophy or the humanities, biosafety raises important ethical issues that have not been adequately examined in the scientific or bioethics literature. This article reviews some pivotal events in the history of biosafety and biosecurity and explores three different biosafety topics that generate significant ethical concerns, i.e., risk assessment, risk management, and risk distribution. The article also discusses the role of democratic governance in the oversight of biosafety and offers some suggestions for incorporating bioethics into biosafety practice, education, and policy.
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Affiliation(s)
- David B Resnik
- National Institute of Environmental Health Sciences, National Institutes of Health, 111 Alexander Drive, Research Triangle Park, NC, 27709, USA.
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Duran-Ahumada S, Karrer L, Cheng C, Roeske I, Pilchik J, Jimenez-Vallejo D, Smith E, Roy K, Kirstein OD, Martin-Park A, Contreras-Perera Y, Che-Mendoza A, Gonzalez-Olvera G, Puerta-Guardo HN, Uribe-Soto SI, Manrique-Saide P, Vazquez-Prokopec G. Wolbachia pipientis (Rickettsiales: Rickettsiaceae) mediated effects on the fitness and performance of Aedes aegypti (Diptera: Culicidae) under variable temperatures and initial larval densities. JOURNAL OF MEDICAL ENTOMOLOGY 2024:tjae088. [PMID: 39077840 DOI: 10.1093/jme/tjae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/19/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
Wolbachia pipientis (Hertig, 1936), also referred as Wolbachia, is a bacterium present across insect taxa, certain strains of which have been demonstrated to impact the fitness and capacity to transmit viruses in mosquitoes, particularly Aedes aegypti (Linnaeus, 1762). Most studies examine these impacts in limited sets of environmental regimes. Here we seek to understand the impacts of environmentally relevant conditions such as larval density, temperature, and their interaction on wAlbB-infected A. aegypti. Using a factorial design, we measured wAlbB stability (relative density, post-emergence in females, and in progeny), the ability for wAlbB to induce cytoplasmic incompatibility, and bacterial effects on mosquito fitness (fecundity, fertility, and body mass) and performance (adult survival and time to pupation) across 2 temperature regimes (fluctuating and constant) and 2 initial larval densities (low and high). Fluctuating daily regimes of temperature (27 to 40 °C) led to decreased post-emergence wAlbB density and increased wAlbB density in eggs compared to constant temperature (27 °C). An increased fecundity was found in wAlbB-carrying females reared at fluctuating temperatures compared to uninfected wild-type females. wAlbB-carrying adult females showed significantly increased survival than wild-type females. Contrarily, wAlbB-carrying adult males exhibited a significantly lower survival than wild-type males. We found differential effects of assessed treatments (Wolbachia infection status, temperature, and larval density) across mosquito sexes and life stages. Taken together, our results indicate that realistic conditions may not impact dramatically the stability of wAlbB infection in A. aegypti. Nonetheless, understanding the ecological consequence of A. aegypti-wAlbB interaction is complex due to life history tradeoffs under conditions faced by natural populations.
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Affiliation(s)
- Sebastian Duran-Ahumada
- Population Biology, Ecology, and Evolution Graduate Program Emory University Atlanta, GA, USA
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Luiza Karrer
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Chun Cheng
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
- Rollins School of Public Health, Emory University Atlanta, GA, USA
| | - Isabella Roeske
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Josie Pilchik
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - David Jimenez-Vallejo
- Population Biology, Ecology, and Evolution Graduate Program Emory University Atlanta, GA, USA
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Emily Smith
- Population Biology, Ecology, and Evolution Graduate Program Emory University Atlanta, GA, USA
| | - Kristina Roy
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Oscar D Kirstein
- Department of Environmental Sciences, Emory University Atlanta, GA, USA
| | - Abdiel Martin-Park
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
| | - Yamili Contreras-Perera
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
| | - Azael Che-Mendoza
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
| | - Gabriela Gonzalez-Olvera
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
| | - Henry N Puerta-Guardo
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
| | - Sandra I Uribe-Soto
- Sciences Faculty, National University of Colombia, Medellin Campus, Medellin, Antioquia, Colombia
| | - Pablo Manrique-Saide
- Laboratory for the Biological Control of Aedes aegypti, Collaborative Unit for Entomological Bioassays (UCBE-LCB), Autonomous University of Yucatan, Merida, Mexico
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Assefa N, Scott A, Madrid L, Dheresa M, Mengesha G, Mahdi S, Mahtab S, Dangor Z, Myburgh N, Mothibi LK, Sow SO, Kotloff KL, Tapia MD, Onwuchekwa UU, Djiteye M, Varo R, Mandomando I, Nhacolo A, Sacoor C, Xerinda E, Ogbuanu I, Samura S, Duduyemi B, Swaray-Deen A, Bah A, El Arifeen S, Gurley ES, Hossain MZ, Rahman A, Chowdhury AI, Quique B, Mutevedzi P, Cunningham SA, Blau D, Whitney C. Comparison of causes of stillbirth and child deaths as determined by verbal autopsy and minimally invasive tissue sampling. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003065. [PMID: 39074089 DOI: 10.1371/journal.pgph.0003065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/02/2024] [Indexed: 07/31/2024]
Abstract
In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD) and prioritize resource allocation and interventions. We aimed to determine the CoD concordance between InterVA and CHAMPS's method. The causes of death (CoDs) of children <5 were determined by two methods using data from seven low- and middle-income countries (LMICs) enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. The first CoD method was from the DeCoDe panel using data from Minimally Invasive Tissue Sampling (MITS), whereas the second method used Verbal Autopsy (VA), which utilizes the InterVA software. This analysis evaluated the agreement between the two using Lin's concordance correlation coefficient. The overall concordance of InterVA4 and DeCoDe in assigning causes of death across surveillance sites, age groups, and causes of death was poor (0.75 with 95% CI: 0.73-0.76) and lacked precision. We found substantial differences in agreement by surveillance site, with Mali showing the lowest and Mozambique and Ethiopia the highest concordance. The InterVA4 assigned CoD agrees poorly in assigning causes of death for U5s and stillbirths. Because VA methods are relatively easy to implement, such systems could be more useful if algorithms were improved to more accurately reflect causes of death, for example, by calibrating algorithms to information from programs that used detailed diagnostic testing to improve the accuracy of COD determination.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anthony Scott
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Merga Dheresa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gezahegn Mengesha
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shabir Mahdi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nellie Myburgh
- Centre pour le Développement des Vaccins), Ministère de la Santé, Bamako, Mali
| | | | - Samba O Sow
- Centre pour le Développement des Vaccins), Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Uma U Onwuchekwa
- Centre pour le Développement des Vaccins), Ministère de la Santé, Bamako, Mali
| | - Mahamane Djiteye
- Centre pour le Développement des Vaccins), Ministère de la Santé, Bamako, Mali
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Emily S Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Afruna Rahman
- Program for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh b, Dhaka, Bangladesh
| | | | - Bassat Quique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique
| | - Portia Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Solveig A Cunningham
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cyndy Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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